The national insurance system of contributory work-related benefits was designed for a ‘core’ workforce in continuous full-time employment. It provides incomplete coverage for the rising numbers of people in the peripheral workforce: part-time jobs, temporary work and self-employment. National estimates are presented for workers whose earnings are below the national insurance threshold, and who are thus excluded from social security benefits such as unemployment, sickness and retirement benefits—roughly 2 million in the period 1985–87. It is estimated that another million workers at least are within the NI net, but outside the income tax net. In addition, there are up to 2 million non-working people who have trivial earnings that leave them outside the NI and tax nets. Homeworkers are found in both these groups. The paper discusses the implications of these findings for claims about the size of the black economy and the characteristics of people participating in the black economy, and for the future development of the social insurance system.

The official figures which appear to show a widening of class differences in health in England and Wales during the post-war period have been controversial partly because they do not fit with common perceptions of what has happened to differences in the standard of living. As a result, a great deal of effort has gone into investigating suggested weaknesses in the decennial social class mortality data. Though initially plausible, the artifactual and selective explanations of the widening mortality differences which were put forward have not usually been borne out by closer investigations. The only fault in the broad picture presented by the official data which we do perhaps need to bear in mind is the tendency for a narrowing of mortality differentials among younger women to be masked by the widening among older women. This paper is an attempt to look at the other side of the coin—namely, to investigate trends in differences in the standard of living in relation to mortality differentials. It concludes that trends in mortality differences have not been related to trends in class differences in average earnings, but have been fairly clearly related to trends in relative poverty. Relative poverty and class differences in mortality declined before the war but have both increased, decade by decade, since the war. Younger women have perhaps been protected from the increase in relative poverty during much of the post-war period by their increased economic activity rates and the relative improvement in earnings of women in poorly paid manual occupations.

The issue of housing and health has received growing attention in recent years. This article reviews why this has been the case and presents the results of the authors' study of housing and health in two areas of West Belfast. A large scale household survey was carried out in Divis Flats and part of the Twinbrook estate, both deprived areas of public sector housing, to compare health and housing conditions. The health of children in Divis is shown to be much worse than the health of children in Twinbrook. Respiratory conditions, diarrhoea, vomiting and psychological distress were particularly common. The health of adults in Divis was also markedly worse than in Twinbrook, and the health of women generally worse than men. The authors conclude that Divis Flats is a contemporary public sector slum and support the case for clearance and rehousing. However, it is argued that the health problems of Divis are one, extreme, manifestation of a wider problem of ill health in low income, ‘mass housing’ areas.

Any preventive policy depends on a set of beliefs which will determine the point and method of intervention in a causative chain of events. In the case of heart disease, diet is seen as a causative factor. Prevention therefore demands a change in national diet. However, policy makers can view diet primarily as a matter of individual responsibility and preferences, or as a reflection of social structures. The individual approach emphasises health education. On the other hand, if dietary change is seen as related to structural factors such as income distribution, the division of resources within households and the power of the food industry, preventive policy must take different forms. The paper analyses food Systems in 61 inner city households in terms of gender, health beliefs, family preferences and status. The findings are compared with the results of large scale surveys. The conclusion is that health education needs to be more specifically directed at men but, more importantly, that a policy which ignores the structural features which limit individual capability for change will inevitably increase the health divide between rich and poor.

Since the early 1970s British and American feminists have developed a comprehensive critique of the dominant doctor/patient relationship within mainstream health care services. In Britain, activists in the women's health movement have struggled to put into practice a model of health care delivery based on feminist principles, within which the doctor/patient relationship is radically redesigned. This paper will explore the principles and practice of this feminist health care model. It will then attempt to evaluate alternative strategies for strengthening and expanding feminist health care within the NHS. The paper will draw on data gathered by the author in 1987 through a series of unstructured interviews with feminist health care providers who were working within a variety of NHS settings in the North West of England.

The theory of incrementalism is a long-standing and influential perspective on policy making and resource allocation in the public sector. Previous research on social services budgeting suggests that resources are allocated incrementally, although there has been some debate as to whether this would persist in an era of prolonged expenditure restraint. Incremental budgetary outcomes are operationalised as percentage changes in budgets pro-rata with percentage changes in the total budget, and as stable shares of total expenditure for each activity. Data for 99 English social service departments supports incrementalism in that budget shares change by only 1.8 per cent, but percentage allocations depart from pro-rata incrementalism by a mean of 74 per cent. The comparison of the two summary indices over time supports those who have argued that prolonged restraint would encourage non-incremental budgeting, but change in the agency's total budget does not consistently predict budgetary outcomes. The effect of restraint on incrementalism varies with the measure used and across the component activities of the measures, but there is enough evidence to suggest a significant decline in the level of incrementalism in social service departments. In particular, non-incremental budgeting is strongly associated with the growth of day centre expenditure on the mentally ill and the elderly before 1982–3, and after that with the pursuit of the ‘community care’ strategy within state provided services for the elderly and children. Incrementalism as a general theory of agency budgeting is limited in its ability to explain variations in the degree of incrementalism between agencies, between component budgets and over time. The conclusion suggests that further research should seek explanations for these variations in the varying balance of the competing forces which shape outcomes in welfare bureaucracies and in the relationship between these forces and the organisation's environment.

Between 1955–7 welfare expenditure in Britain came under serious attack. The main protagonist was the Treasury and its chosen implement a five-year review of the social services, to be presided over by a ministerial Social Services Committee. The attack rebounded, for the Committee provided the opportunity for the consolidation of the defence of welfare expenditure and for a frontal attack on Treasury assumptions. This neglected episode in Conservative government social policy places in historical context the early defeat of monetarism (with Thorneycroft's resignation in 1958) and provides the background to the establishment of the Plowden Committee and of the Public Expenditure Survey Committee. It also raises questions about the degree of post-war consensus and the failure to make the constructive development of the welfare state an objective of ‘conviction’ politics.

It is widely recognised that there are many problems with the community care policy for the mentally ill which has been in operation in England and Wales since the late 1950s. However, many existing accounts of the development of the policy rest upon a variety of erroneous assumptions about how it has evolved, and which in turn affect our understanding of how it might be changed. Some of these assumptions are examined, and it is argued that frequently they fail to acknowledge how both the rhetoric and the reality of the policy have developed. Taking this critique into account, a more accurate assessment of how to understand community care for the mentally ill is offered.

There has been growing concern over the consequences for public expenditure of an increasing number of elderly people dependent on a relatively diminishing working population. This concern stems largely from demographically determined dependency ratios and it is not necessarily the case that a change in the age profile of the population will lead to a greater burden of dependency. The ‘engine of dependency’ is shown to have at least two other cylinders—patterns of labour-force participation across age and gender, and levels of unemployment. Policy to date has had a surprisingly narrow focus in view of the dual role of economic and demographic forces in influencing the ratio of dependency. The economic and political feasibility of alternative policy options is discussed.

A recent edition of this Journal (Volume 16, Part 2, April 1987) was devoted to a number of articles on the definition and measurement of poverty. Surprisingly, perhaps, this did not include any specific discussion of gender differences in the causes, extent and experience of poverty. But such gender differences do exist, though they are often obscured by much research on poverty. Our initial response to the special edition on poverty was to write a reply discussing how the various contributors had ignored the issue of gender. But women cannot simply be ‘added in’ to existing analyses; instead a different analytic framework is required. This article therefore begins by looking at some of the widespread evidence of the economic disadvantage of women compared with men. We then go on to discuss why it is necessary to focus on the gender dimensions of poverty. We argue that this involves far more than simply disaggregating data to produce statistics about the situation of women. Rather, this focus leads us to explore the structural causes of women's poverty and the gendered processes in the labour market, welfare systems and domestic household which interact to create and maintain that disadvantage. In the final section we consider some of the important conceptual and methodological issues which must be tackled if we are to find ways to investigate and measure poverty which are not gender-blind.

Carers occupy an ambiguous position within the social care system. Services are predominantly structured around the dependant rather than the carer, and this has important consequences for their delivery and evaluation. Many of the problems that arise in thinking about carer issues relate to confusion over the way the relationship between social care agencies and informal carers should be perceived. The paper outlines three models that provide frames of reference for this relationship: carers as resources; carers as co-workers; and carers as co-clients. The tensions between these are then used to explore the contradictions of policy in this field.

The abolition in 1982 of the Earnings-Related Supplement (ERS) to unemployment benefit, which had been introduced in 1966, left the UK with no element of income support for the unemployed linked to previous earnings. The ERS scheme represents an important case study of economic and social policy but it has been little researched hitherto. The paper examines the history of ERS, showing how the original legislation and subsequent development produced a benefit that bore little relation to schemes in other countries. Unpublished administrative data on the receipt of ERS are used to help document the scheme's failings, and the paper closes by placing ERS within the context of the development of unemployment insurance in Britain.

This paper examines the historical context of the policy decision of the (then) DHSS in July 1974 to establish Regional Secure Units with an initial provision for 1,000 places. A brief examination of the history of the detention of the criminally insane and the setting up of the county asylums is followed by an examination of the various problems faced by the authorities concerned with the care of the criminally insane and the mentally ill in general in the 1960s. The paper examines the different streams of influence and power that converged upon this solution: government, special hospitals, public inquiries, unlocking of hospital wards, criminal law, DHSS and the Home Office, judges, voluntary bodies, prisons, psychiatrists and the official government reports known as the Glancy and the Butler Reports. The paper seeks to explain the policy decision to build regional secure units as a dynamic outcome arising from the confluence of opportunities, participants and solutions: a policy formation model put forward by March and Olsen (1976).

This paper provides a case study of the involvement of carers in planning services for mentally handicapped people under the All Wales Strategy (AWS). After describing the structure for consumer participation in the AWS in Gwynedd, reasons for the low level of participation found are examined before considering what can be learnt from these early experiences. Major changes in the planning structure implemented after a review of the system are outlined. The paper ends with a discussion of the major operational principles which might underlie an effective system of consumer participation.

Within both publicly and privately financed health care Systems different funding mechanisms have evolved, or have been proposed, to deal with the problem of ‘moral hazard’. Moral hazard arises when financial incentives within the health care System lead to either inefficient demands for care by consumers or inefficient supply of care by providers. In this paper the problem of moral hazard is outlined in more detail, and different ways of countering moral hazard are reviewed in terms of three criteria: effect on patient utilisation of health services in general; effect on utilisation by different groups of patients; and effect on health status. It is concluded that evidence on different methods of funding health services can only be judged in the context of objectives. If the objectives of health care delivery are ‘maintenance or improvement of health’ and ‘equal access for equal need’ then charges and finance of care through health maintenance organisations both appear to be less favourable than ‘free’ care at the point of delivery whilst the latter is not necessarily more costly as a resuit. Research on other suggested alternatives is required, otherwise radical changes to health care financing in the UK will simply result in movement from one unproven system to another.

The determination of the different needs of families of different compositions is necessary in order to ensure horizontal equity in tax/transfer policies. Despite the seeming simplicity of the problem, a consensus as to the appropriate means of determining relative need remains elusive. One approach which has been proposed has been to use social surveys to analyse the relationship between subjective evaluations of well-being and incomes. This paper examines such methods, and discusses the key assumptions upon which they rest. An explanation is advanced as to why these methods may lead to an understatement of the differences in relative needs of different family types.

Legislation in 1985 and 1986 has attempted to give new impetus to the growth of occupational and personal pension schemes. This article demonstrates that, because of the interaction between occupational pensions and means-tested social security provision, many of today's pensioners receive little or no financial benefit from their occupational pension. The evidence presented is consistent with the thesis that the pensioners who are worst affected by the ‘pension trap’ include those who, as workers, were low-paid and experienced interrupted employment. As a consequence they reached retirement with small state and occupational pensions, limited savings and no house which they owned. Many are women. The penetration of occupational and personal pensions is currently lowest among the same groups of workers and it could be that the Government's policy to extend the coverage of private pensions will result in an increase in the severity of the pension trap. Some measures for reducing the impact of the pension trap are discussed.

For over 15 years the Centre for Social Policy at the University of Antwerp has been involved in research on social security. More specifically, it has tried to develop research methodologies which would make it possible to quantify the adequacy of the social security system in Belgium, and to assess its impact on the income of households. The first part of this article provides a broad outline of the social security system in Belgium. The second and major part presents the main results of the research. The same methodology and the same standardised presentation of results is currently being used in a comparative study financed by the Commission of the European Community and undertaken by research groups in Belgium, the Netherlands, Luxembourg, France, Ireland, Spain and Greece.

Two decades ago allegations of religious discrimination and the onset of ‘the troubles’ led the British Government to institute a programme of administrative and legislative reform in the province. These reforms culminated in the Fair Employment Act (1976). More recently, the Government began a review of the efficacy of the existing legislation and this has now resulted in a new Fair Employment Bill for Northern Ireland. The new Bill should be seen as a serious attempt to grapple with the chronic problem of religious discrimination in the province. The realisation of equality of opportunity in Northern Ireland, however, continues to be as much a test of political will as of the ability of those who frame ‘fair employment’ legislation.